Pyogenic Spondylitis Caused by Methicillin-Resistant Staphylococcus aureus Associated with Tracheostomy followed by Resection of Ossification of the Anterior Longitudinal Ligament

• Main Authors: Michio Hongo, Naohisa Miyakoshi, Masashi Fujii, Yuji Kasukawa, Yoshinori Ishikawa, Daisuke Kudo, Yoichi Shimada
• Format: Article
• Language: English
• Published: Hindawi Limited 2018-01-01
• Series: Case Reports in Orthopedics
• Online Access: http://dx.doi.org/10.1155/2018/9076509

Symptomatic ossification of the anterior longitudinal ligament (OALL) is rare. However, when the osteophyte enlarges and obstructive symptoms occur, the patient may require surgery. We present a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus associated with tracheostomy followed by resection of OALL. A 69-year-old woman with OALL complained of dysphagia and suffocation, which was caused by prominent OALL at C4-5. Tracheostomy was performed, followed by osteophytectomy 6 weeks later. Two months after osteophytectomy, she complained of muscle weakness of the extremities, neck pain, and elevated temperature. Magnetic resonance imaging showed an intensity change at the C4-5 vertebrae and an epidural abscess that was causing cord compression requiring urgent decompression. Cultures identified methicillin-resistant Staphylococcus aureus. As osteolytic change and muscle weakness gradually progressed, she underwent anterior and posterior reconstruction with an autograft and instrumentation. Bone union was confirmed at 1 year postoperatively with improvement in neurological status. OALL has potentially the risk of airway obstruction. Therefore, appropriate diagnosis and prompt osteophytectomy are needed in cases of a large prominent ossification that puts the patient at risk of suffocation. However, it is noted that osteophytectomy following urgent tracheostomy carries the possible risk of infection.